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Nicky Manning - One of the best experts on this subject based on the ideXlab platform.
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Fetal Cardiology - Chapter 15 Heart muscle disease
Oxford Medicine Online, 2011Co-Authors: Nick Archer, Nicky ManningAbstract:Introduction 220Types of heart muscle disease 222Assessment 228Treatment 230Heart muscle disease in the fetus can be a 1° (often genetically determined) abnormality or 2° to another disease process in the fetus or the mother. These functional types of heart muscle disease are discussed in this chapter....
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Fetal Cardiology - Chapter 4 History and examination
Oxford Medicine Online, 2011Co-Authors: Nick Archer, Nicky ManningAbstract:History 42Examination 44As in any area of medicine, assessment of the Fetal cardiovascular system should begin with sufficient accurate information to allow a proper assessment and relevant counselling to be carried out. Aspects of the history are considered under 3 headings of information that should be available before investigation is performed and, in some cases, before referral to a Fetal cardiac clinic. Much of the information should be available in maternity notes but some specific details often need clarifying....
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Fetal Cardiology - Chapter 22 The heart in the sick fetus
Oxford Medicine Online, 2011Co-Authors: Nick Archer, Nicky ManningAbstract:Introduction 292Maternal causes 294Fetal causes 298• The fetus is vulnerable to a changing environment including any factors brought about by compromised maternal well-being.• Major factors determining cardiac output are discussed in other chapters ( see Chapter 13, Fetal cardiac rhythm, pp.165...
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Fetal Cardiology - Chapter 2 Aetiology of structural congenital heart disease
Oxford Medicine Online, 2011Co-Authors: Nick Archer, Nicky ManningAbstract:Introduction 18Environmental factors 20Genetic factors 26Risk of associated non-cardiac anomalies 32Prevention of congential heart disease 34• The incidence of congenital heart disease (CHD) is approximately 8:1000 lives births but is higher in the prenatal population.• The aetiology of CHD has been considered to be multifactorial—a combination of environmental factors and a genetic predisposition but increasing numbers of specific genetic causes are being identified....
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Fetal Cardiology - Chapter 19 Nuchal translucency and the heart
Oxford Medicine Online, 2011Co-Authors: Nick Archer, Nicky ManningAbstract:Introduction 264The nuchal scan 266Management 268Nuchal translucency describes sonolucent tissue in the posterior aspect of the Fetal neck; the size can be measured with accuracy during the 1st trimester of pregnancy and an increase in the measurement is associated with an increased risk of chromosomal abnormality. If Fetal karyotype is normal: ...
John M. Simpson - One of the best experts on this subject based on the ideXlab platform.
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P22 Early experience of multi-sequence Fetal cardiac magnetic resonance imaging within a clinical Fetal Cardiology service
Heart, 2016Co-Authors: David F. A. Lloyd, Owen Miller, Gurleen Sharland, John M. Simpson, Joshua F. P. Van Amerom, Kuberan Pushparajah, Vita Zidere, Joanna M. Allsop, M. Fox, Christina MalamateniouAbstract:Background Fetal cardiac MRI offers the potential for a safe, radiation-free adjunct to echocardiography. In practice, its use has been limited by the technical challenges imposed by the small size of the Fetal heart, the lack of external gating, and gross Fetal and maternal movements. We present our initial experience of 20 Fetal cases assessed by MRI, referred after routine Fetal Cardiology assessment to resolve specific points of diagnostic uncertainty. Methods Referrals were based on the judgements of the attending Fetal cardiologists between June 2014 and May 2015. Following a three-plane localiser, gross Fetal movement was assessed with a balanced steady-state free precession (bSSFP) cine. Half-Fourier single-shot turbo spin echo (HASTE) and bSSFP gradient echo sequences were used for diagnostic imaging. The MRI diagnosis was subsequently compared with postnatal findings. Results 20 Fetal cardiac MRI scans were performed over the referral period, at an average gestational age of 32 +4 weeks, (range 26 +4 –38 +1 weeks). 3 scans were abandoned due to excessive Fetal movement or inadequate visualisation. The most frequent referral indications were suspected coarctation of the aorta/abnormal arch anatomy (n = 9), cardiac masses or diverticulums (n = 5), and assessment of pulmonary vasculature (n = 4). HASTE sequences produced T2-weighted “black-blood” images, useful for assessing extracardiac vasculature (figure 1). Balanced SSFP sequences showed good contrast between the blood pool and surrounding tissue and were useful for intracardiac structures; however these were more susceptible to motion artefacts. Real-time SSFP sequences allowed for dynamic assessment of moving structures (e.g. masses/diverticulums-figure 2). Using a combination of sequences we were able to accurately characterise rhabdomyomas in 3 patients. In total, of the 17 scans with useful data, MRI was diagnostic in 15. Neonatal coarctation was incorrectly predicted in one case, and no postnatal data was available in another due to Fetal demise. Conclusions Certain Fetal cardiovascular abnormalities may be difficult to diagnose with ultrasound alone, reflected in the referral pattern we observed for MRI. Our preliminary experience suggests that MRI can provide safe and useful complimentary imaging in this cohort within a tertiary Fetal cardiac unit. As technical challenges continue to be addressed, prenatal MRI may develop a more prominent role in routine Fetal cardiovascular assessment.
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P14 Significance and associations of aberrant right subclavian artery in the Fetal Cardiology setting
Heart, 2016Co-Authors: Elena Greco, John M. Simpson, Vita Zidere, Trisha V. Vigneswaran, Ranjit Akolekar, Kypros H. NicolaidesAbstract:Background The aberrant right subclavian artery (ARSA) is the most common branching abnormality of the aortic arch, with an estimated prevalence of 0.5–2% of the population. This anomaly is defined anatomically by the unusual course of the right subclavian artery (RSA), which arises as a fourth vessel from the descending aorta, arriving at the right arm via a path looping behind the trachea and the oesophagus. ARSA is usually asymptomatic in children and poses no implications from the cardiovascular point of view. Pathological and clinical studies have shown the prevalence of ARSA to be significantly increased in individuals with congenital heart defects (CHD) and particularly so, in those with trisomy 21. Several papers have also suggested a strong association of ARSA with other chromosomal and genetic syndromes including 22q11.2.deletion. Objectives The aim of this study was to describe the prevalence of chromosomal and non-chromosomal syndromes and CHD in a series of 360 consecutive fetuses diagnosed with ARSA in our Fetal Cardiology clinic. Material and methods Retrospective analysis of fetuses diagnosed with ARSA during an eight years period (2006–2014). Diagnosis of ARSA was made in transverse three-vessels/arch view with colour flow mapping (Figure 1). Invasive prenatal diagnosis was discussed according to the risk for aneuploidies as adjusted for the presence of ARSA and/or associated cardiac and extra-cardiac abnormalities. Prenatal data were combined with outcome obtained from medical records, pathological examinations and telephone interviews with patients. Results ARSA was an isolated cardiac finding in 78% (281/360) of cases and associated with a major CHD such as tetralogy of Fallot and hypoplastic left heart syndrome in 22% (79/360). A full karyotype was performed in 60% (217/360) of pregnancies, including 83% of those with ARSA and CHD (66/79) and 54% (151/281) of those where ARSA was an isolated cardiac finding. An abnormal karyotype including trisomy 21 and 22q11.2 deletion was found in 64% (42/66) of cases where ARSA was associated with complex CHD. Trisomy 21 was detected in 25% (37/151) of fetuses with ARSA as an isolated cardiac finding and other aneuploidies in further 7% (11/151) of cases. In our series, there were no cases with 22q11.2 deletion identified where ARSA was an isolated cardiac finding and the majority (76%; 213/281) were livebirths with uneventful postnatal outcome. Conclusions Our results are consistent with published literature, which suggests that finding of an ARSA should prompt referral to a specialist Fetal cardiologist to rule out underlying cardiac defects. A detailed Fetal anomaly scan should be performed in order to examine for features of chromosomal abnormalities and invasive testing should be discussed accordingly. If the Fetal karyotype is normal and there are no significant cardiac/extracardiac defects, an isolated ARSA is a benign finding with a good postnatal outcome. There is insufficient data from our study to report on association of ARSA with 22q11.2deletion.
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Fetal aortic valve stenosis: a critique of case selection criteria for Fetal intervention.
Prenatal diagnosis, 2015Co-Authors: Lindsey E. Hunter, Henry Chubb, Owen Miller, Gurleen Sharland, John M. SimpsonAbstract:Objective Selection of fetuses with aortic stenosis (AS) for prenatal intervention has been influenced by published scoring systems. This study aimed to test these scoring systems by retrospective application to consecutive cases of Fetal AS. Methods Retrospective analysis of the echocardiographic findings of 31 consecutive fetuses with AS evaluated at a tertiary Fetal Cardiology centre. Published ‘eHLHS’ scores and threshold scores were applied to the group and compared to postnatal management, in terms of biventricular repair versus single ventricle palliation. Results Thirty-one fetuses were identified with AS, and eHLHS was identified in 17 at the initial echocardiogram. No fetus with a full eHLHS score (3/3 or 4/4) achieved a biventricular repair. Three fetuses had a favourable threshold score (≥4), one of whom had a successful biventricular outcome. Seven fetuses had an unfavourable threshold score (
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The role of telemedicine in a Fetal Cardiology service
Archives of disease in childhood. Fetal and neonatal edition, 2011Co-Authors: John M. SimpsonAbstract:The recognition of congenital heart disease (CHD) during ‘routine’ obstetric anomaly scans continues to be a challenge. Recent national guidance has strengthened previous recommendations and advocated the incorporation of views of cardiac situs, four-chamber view and outflow tracts into such scans.1 An increasingly important question is how Fetal cardiologists can best support district hospitals, first in terms of training and second to provide support if a cardiac abnormality is suspected. The article by McCrossan and colleagues in this month's journal2 provides an important contribution relating to the role of telemedicine in the delivery of a system for prenatal detection and management of CHD. These authors reported on several facets of the application of telemedicine in Fetal Cardiology practice including technical feasibility, service organisation and quality control. From a technical perspective, application of telemedicine to the Fetal heart demands high spatial and temporal resolution due to the small size of the Fetal heart and rapid heart rate. With availability of the appropriate equipment in the district and tertiary hospital coupled with sufficient bandwidth for image transfer, the study of McCrossan reported a high degree of satisfaction with the image quality received at the remote tertiary site, with image scores that were, unsurprisingly, higher in those cases with favourable Fetal lie. This permitted reassurance of normality in a significant number of cases where …
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Recommendations for the practice of Fetal Cardiology in Europe.
Cardiology in the young, 2004Co-Authors: Lindsey D. Allan, Gurleen Sharland, John M. Simpson, Joanna Dangel, Vlasta Fesslova, Jan Marek, Mats Mellander, I. Oberhänsli, Renate Oberhoffer, Sven-erik SonessonAbstract:F ETAL CARDlOLOGY IS CURRENTLY PRACTISED IN of rhythm. An early accurate diagnosis will make most European countries, blit even within possible parental choice, as well as providing the countries there is a great variation in the service opportunity to plan the delivery and postnatal provided. The recommendations provided in this management so as to optimize the outcome, document are intended to be guide for all paediatric Support can also be provided to specialists in Fetal cardiologists undertaking Fetal echocardiography with medicine, and to obstetricians, in the management the view of providing a service in Fetal Cardiology. It is of fetuses with functional disturbances, as in tWinclear that the health and legal systems vary from counto-tWin transfusion syndrome try to country, so that not all aspects of these recomb. To provide appropriate counselling and support mendations Can be implemented in all countries, The for parents and families following prenatal recommendations, nonetheless, provide a framework diagnosis l that can be adapted to fit in with local situations, c, To communicate results to the referring obstetri-
O Uzun - One of the best experts on this subject based on the ideXlab platform.
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Change in referral and diagnostic trends in Fetal cardiac screening over 7 years in south wales
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2011Co-Authors: P N Gopalakrishnan, A Sinha, O UzunAbstract:Aim To identify the reasons for referrals, foetal demise, termination of pregnancies in relation to foetal heart conditions, trend in yield rate and place of delivery. Methods Retrospective review of all the tertiary foetal Cardiology referrals in South Wales, UK from 2002 to 2008. Results A total of 1744 mothers were referred for tertiary Fetal Cardiology assessment of which 1280 (73%) were normal. 442 (25%) of foetuses had confirmed cardiac anomalies. Reasons for referral Structural heart anomalies-37%, associated congenital anomalies-9%,family history of congenital heart disease-22%,foetal arrhythmias-10%, maternal congenital heart disease-6%, increased nuchal thickness-15.5%. Fetal demise Hypoplastic condition-31%, AVSD9s-31%,tetrology of fallot-7%,outflow tract -left ventricular (3%),right ventricular(7%),ebsteins-7%, other conditions-14%. Termination of pregnancies Hypoplastic conditions- 36%,AVSD9s-23%,transposition of great arteries-11%,truncus arteriosus-5%,tetrology of fallor-4%, right sided -7%;left sided5% obstructive lesions. Total yield rate (confirmed foetal cardiac anomaly) Increased from12%-2002,17%-2003,22%-2004,31%-2005,37%-2006,39%-2007 and 49%-2008. Place of delivery 68% were delivered in tertiary cardiac centres,20% were delivered in neonatal intensive care centres and 12% were delivered in district general hospitals with high dependency neonatal support only. Conclusions Structural heart anomalies and family history of congenital heart conditions were the main reasons for tertiary Fetal Cardiology assessment. Hypoplastic heart conditions and atrio ventricular septal defects were the main reasons for foetal demise and termination of pregnancies. Successful training of antenatal ultrasonographers in including outflow tract views in addition to the routine four chamber view led to increase in yield rate. Early identification of major congenital cardiac anomalies and counselling led to delivering in tertiary cardiac surgical centres.
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Analytical view into the experiences of women referred to the Fetal heart scanning clinic who subsequently receive a diagnosis of Fetal cardiac abnormality during pregnancy
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2011Co-Authors: S Bennett, A Hedgecoe, O UzunAbstract:This research investigates the experiences of women who receive a prenatal diagnosis of congenital heart disease, the patient perception of the referral process to the Fetal Cardiology service and factors contributing to decision-making during pregnancy. This qualitative research involved semi-structured face-to-face interviews with seven women who had recently received a diagnosis of a Fetal heart condition. All interviews were audio recorded and later transcribed to allow thematic analysis to be performed. The most important findings of this research were the high levels of anxiety experienced by participants while waiting to see a Fetal cardiac specialist for confirmation of the diagnosis. Receiving the diagnosis of a Fetal heart problem resulted in heightened stress levels in all participants although counselling provided by the Fetal Cardiology team was very effective. Other findings included factors contributing to the decision to undergo invasive prenatal testing and difficulties with communicating the diagnosis to others, although written information and schematic diagrams provided by the Fetal cardiologist were considered very helpful in this process. Additionally, pre-planned delivery in a specialist centre was regarded as very reassuring. The results of this study indicated the need for more information to be given by practitioners when an abnormality is first suspected. However the practicalities and appropriateness of the implementation of this require further research. All participants were in agreement that they had benefited from the technology and medical expertise enabling their baby9s diagnosis prenatally and all were satisfied with the care and support provided to them by the Fetal Cardiology team.
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Outcome of ante-natally suspected congenital cardiac conditions in Wales over a period of 7 years 2002–2008
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2010Co-Authors: Pn Gopalakrishan, A Sinha, D Tucker, O UzunAbstract:Aim To determine the reasons, outcome of ante-natally detected congenital heart conditions, incidence with associated co-morbid conditions and the recurrence rate of congenital heart conditions with maternal and Fetal conditions in Wales over a period of 7 years 2002–2008. Methodology Retrospective study of 1747 referrals for tertiary Fetal Cardiology evaluation. Data were obtained from Fetal medicine, radiology, neonatal, Cardiology databases and case notes. Results The incidence of congenital heart disease in Wales in 13 per 1000 live births. 1747 mothers were referred to Tertiary Fetal Cardiology assessment. Initial echocardiogram was normal in 1305 (73%) of mothers and discharged from follow up. Abnormal cardiac anatomy and family history of congenital heart disease were the main reasons for referral to Fetal Cardiology. 62% of Fetal demise was contributed by Hypoplastic conditions and AVSDs atrial ventricular septal defect. 64% of terminations were due to four chamber abnormalities. Outflow tract abnormalities remains significant in postnatally detected conditions. 88% of the foetuses with major cardiac anomalies were delivered in paediatric cardiothoracic surgical centres. The incidence of congenital heart disease with maternal insulin dependent diabetes mellitus is 3.7%, with genetic conditions is 30.4% and with associated congenital anomalies is 30%. The recurrence risk for congenital heart disease with family history is 3.7%, with mother herself having congenital heart disease is 8% and with previous pregnancy having major heart conditions is 6.5%. Conclusion The incidence of congenital heart conditions in Wales is high. The pickup rate of outflow tract anomalies was significantly improved after sonographers training programme by the Fetal cardiologist.
Nick Archer - One of the best experts on this subject based on the ideXlab platform.
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Fetal Cardiology - Chapter 15 Heart muscle disease
Oxford Medicine Online, 2011Co-Authors: Nick Archer, Nicky ManningAbstract:Introduction 220Types of heart muscle disease 222Assessment 228Treatment 230Heart muscle disease in the fetus can be a 1° (often genetically determined) abnormality or 2° to another disease process in the fetus or the mother. These functional types of heart muscle disease are discussed in this chapter....
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Fetal Cardiology - Chapter 4 History and examination
Oxford Medicine Online, 2011Co-Authors: Nick Archer, Nicky ManningAbstract:History 42Examination 44As in any area of medicine, assessment of the Fetal cardiovascular system should begin with sufficient accurate information to allow a proper assessment and relevant counselling to be carried out. Aspects of the history are considered under 3 headings of information that should be available before investigation is performed and, in some cases, before referral to a Fetal cardiac clinic. Much of the information should be available in maternity notes but some specific details often need clarifying....
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Fetal Cardiology - Chapter 22 The heart in the sick fetus
Oxford Medicine Online, 2011Co-Authors: Nick Archer, Nicky ManningAbstract:Introduction 292Maternal causes 294Fetal causes 298• The fetus is vulnerable to a changing environment including any factors brought about by compromised maternal well-being.• Major factors determining cardiac output are discussed in other chapters ( see Chapter 13, Fetal cardiac rhythm, pp.165...
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Fetal Cardiology - Chapter 2 Aetiology of structural congenital heart disease
Oxford Medicine Online, 2011Co-Authors: Nick Archer, Nicky ManningAbstract:Introduction 18Environmental factors 20Genetic factors 26Risk of associated non-cardiac anomalies 32Prevention of congential heart disease 34• The incidence of congenital heart disease (CHD) is approximately 8:1000 lives births but is higher in the prenatal population.• The aetiology of CHD has been considered to be multifactorial—a combination of environmental factors and a genetic predisposition but increasing numbers of specific genetic causes are being identified....
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Fetal Cardiology - Chapter 19 Nuchal translucency and the heart
Oxford Medicine Online, 2011Co-Authors: Nick Archer, Nicky ManningAbstract:Introduction 264The nuchal scan 266Management 268Nuchal translucency describes sonolucent tissue in the posterior aspect of the Fetal neck; the size can be measured with accuracy during the 1st trimester of pregnancy and an increase in the measurement is associated with an increased risk of chromosomal abnormality. If Fetal karyotype is normal: ...
Lisa K Hornberger - One of the best experts on this subject based on the ideXlab platform.
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Fetal diagnosis and imaging in Cardiology
Expert opinion on medical diagnostics, 2008Co-Authors: Lisa K HornbergerAbstract:Background: Fetal echocardiography plays a critical role in the diagnosis and management of structural, functional and rhythm-related Fetal cardiovascular disease. Objectives/methods: This article reviews the history of Fetal echocardiography and the prenatal diagnosis of Fetal cardiovascular disease as well as the evolution of the field of Fetal Cardiology. The clinical application of Fetal echocardiography, including indications for referral, timing of referral and considerations in the diagnosis and serial assessment of Fetal cardiovascular disease, is presented. Conclusions: Newer directions in the field of Fetal Cardiology, including first trimester diagnoses and Fetal intervention, will continue to expand its role in the evaluation and treatment of affected pregnancies in the future; however, equally as important are efforts to continue to improve prenatal detection rates.
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Echocardiographic assessment of Fetal arrhythmias
Heart (British Cardiac Society), 2007Co-Authors: Lisa K HornbergerAbstract:Fetal arrhythmia assessment can at times be a challenging task. With the potential for evolution of Fetal heart failure in both tachy‐ and bradyarrhythmias, and availability of successful strategies to treat and prevent progression, however, it is a critical aspect of Fetal Cardiology. Although Fetal ECG has been described, low P wave amplitudes, difficult signal acquisition from 27 to 34 weeks, and use of signal averaging limit its clinical utility.1 Fetal magnetocardiography, the magnetic analogue of Fetal ECG is a promising modality,2 but it is currently available in only a few centres. To date, the routine evaluation of Fetal heart rate and rhythm has relied largely on the use of M‐mode and Doppler techniques, which provide information about mechanical activity of the atria and ventricles used to reflect indirectly electrophysiological events.
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textbook of Fetal Cardiology
2000Co-Authors: Lindsey D. Allan, Lisa K Hornberger, Gurleen SharlandAbstract:1. Introduction: past and future 2. Normal and abnormal cardiac development 3. Fetal cardiovascular physiology 4. Indications for Fetal echocardiography 5. The normal Fetal heart 6. Abnormalities of systemic and pulmonary venous connections 7. Abnormalities of the atrial septum 8. Abnormalities of the A-V junction 9. Abnormalities of the ventricular septum 10. Abnormalities of the ventriculoarterial junction 11. Aortic arch anomalies 12. Abnormalities of the arterial duct 13. Heterotaxy syndromes 14. Isomerism of the atrial appendages 15. Miscellaneous lesions 16. Parental counseling 17. Obstetrical management of pregnancies complicated by Fetal heart disease 18. Outcome after prenatal diagnosis of CHD 19. Fetal arrhythmias 20. Fetal echocardiography in the diagnosis of obstetric pathology 21. Fetal and obstetric ultrasound: an overview 22. Genetics of CHD 23. Fetal cardiac surgery 24. 3D echocardiographic reconstruction of the Fetal heart 25. Transvaginal Fetal echocardiography 26. Fetal congestive heart failure Appendix.